Category Archives: Improvements

I like this quote because it touches on a couple of other ideas I have read before. One author I like (Joiner) states that all leaders need to treat decisions as experiments. Lean challenges HiPPOs (Highest Paid Persons Opinion) to use data in decision making instead of through assertiveness or by being charismatic. The quote below is a good reminder to always experiment with theories to be able to show data if the theory is true or not. It also helps me really notice when opinions are made verses asking for objective data to support.

“In a world without data, opinion prevails…Most managerial dictums are hypotheses. A hypothesis by nature is useless unless proven by data…Asserting an opinion as a fact is a lot easier. Pretending that our assuredness reflects objective truth is certainly convenient …we need to test our beliefs against data…Managers must see themselves as experimenters who lead learning, not dictators who impose control.” – Peter Scholtes “The Leader’s Handbook pages 29,33

This quote has been sitting with me a while and I hope it is relevant for you too. So often, even a gemba experience may be different for people. Even though facts are found at gemba, people may only see certain things and not the whole picture (like the four men & elephant story). I think the Respect For People principle is at play here too because it suggests to mutually respect multiple perspectives and put together into one common view.

“Most disagreements about the right solution, decision, or course of action are really disagreements about the interpretation of current reality…Most statements about current reality are not wrong; they are incomplete. The person who adopts this principle seeks to put multiple views of current reality together to build one common and more complete view of it.” – The Hitchhiker’s Guide to Lean: Lessons from the Road by Jamie Flinchbaugh and Andy Carlino

“Beliefs, behaviors, assumptions, and attitudes do not change through study, conferences, seminars, and training classes; they change through repeated action. This is not dissimilar to breaking unhealthy habits such as smoking or overeating. The consistently repeated lean actions and restraint from doing old non-lean things are undoubtedly ‘painful’ in the beginning” (source: The Kaizen Event Fieldbook by Hamel pages 61-62)

I recently uncovered a box of books I thought was lost years ago (before I knew about 5S!) This time capsule contained material I read about 15 years ago while still in college and managing my own direct sales business during summer breaks. It was fun to flip through my dusty paperbacks and read my notes. One of these books was “Unlimited Power” by Tony Robbins. Little did I know it at the time, this influential book was my first introduction to Plan-Do-Study-Adjust thinking!

Robbins writes about what he refers to as the Ultimate success Formula and points out that this is the consistent path of people who have attained excellence. Here are the steps:

Know your outcome

Take action

Recognize if your actions are taking you closer to your goal or farther away

Develop the flexibility to change your behavior until you get what you want

These steps directly reflect the Shewhart PDSA Cycle which is a core principle for Lean practitioners. I truly think it is the ultimate success formula!

By following PDSA, you will save yourself the waste that comes from doing an activity without knowing the outcome you want. You won’t be stuck in analysis paralysis and will actually do something to make improvements. You will continuously improve when you seek evidence from your actions to see if they are producing what you expect. Being able to adjust and change your approach in order to achieve the results you want will put you miles ahead of someone who keeps trying different variations of the same thing but never getting different outcomes.

One big learning I had from re-discovering this book is that I have been drawn to this kind of improvement thinking for my entire professional working career. Even tough I didn’t know what Lean was, I was getting a little glimpse of it!

2012 is the year to be a difference maker for all of us. We have a lot of opportunity to make things better for our customers and better engage our teams. Here are some tips to make a deep impact this year:

Embrace The Kaizen Spirit: Masaaki Imai says “The Kaizen spirit encourages thinking about how to change, rather than why it can’t be done.” Don’t let the excuses (even really good ones) hold you back from looking to find a way to make a difference. As Mark Graban suggested recently, let the identified barriers become your first problem statement.

See How Your Role Makes A Difference: Seek to discover how your role directly makes things better for customers or how it supports those that interact with them. Also consider what you can do to make a difference with the people on your team by being a better listener, encourager, or other things that help people make improvements.

Be Approachable: If people avoid talking with you, you can’t make a difference because you will not understand the current situation. Being inclusive allows you to build trust and begin to help influence positive changes.

I am sure many of my readers are already making huge impacts on people’s lives and in the organizations they work with. What other suggestions do you have for people to be a difference maker this year?

Have you dreamed of eating the Grove Café’s world famous pancakes or been lucky enough to try them yourself? What? You never heard of them before now? It almost sounds like a classic Onion article.

Many hospitals aspire to be “World Class” but there is no measure to know if they succeed at it. Just like the pancakes, only that hospital seems to define themselves as achieving that level of success. For that matter, I am not sure what would make them stand out with that definition since a Google search of “world class” and hospital returned 47,300,000 results.

Do patients choose a hospital based on a world class definition? Similarly, do local “top doctor” magazines drive patients to hospitals or is the US NEWS” Top Hospitals” issue a key deciding factor (despite its questionable criteria)?

I would worry about achieving the level of “World Class” (whatever that actually means) since being at the top of a benchmark usually does not inspire people to improve once attained.

I think a better mission for hospitals is to strive for “perfect care”. Patients deserve predictable clinical outcomes and they shouldn’t get harmed or sicker by being in a hospital. Patients want better customer service and should not have to experience any unnecessary waits. Lastly, healthcare should have a fair and reasonable price for their co-pay and insurance.

Hospitals need to ask their patients if they want to be treated at someplace famous or where they will receive perfect care. If forced to choose one over the other, which would they pick? Focusing on the means (providing perfect care) will help hospitals achieve outcome of being deemed world class.

Does your workday frequently feel like mayhem? I have talked with many people who feel like their job is filled with unnecessary chaos. I believe a lot of organizations self-inflict themselves with craziness. There is a way to stop the mayhem!

Overburdening people (and equipment) is a form of waste. Your organization must first identify where people experience this waste. Usually it is very easy to find just by asking who feels they are overwhelmed.

Here are some examples of what you may find (also note that most below do not have a paying customer waiting for the outcome):

Leaders asking for non-standard reports with quick deadlines (usually to sit on their desks for weeks before they look at them)

Constant edits or change of direction to documents because planning is often done afterthe content was created

Support departments get projects dumped on them without ever problem solving around their ability to have capacity to do the work

The next step is to acknowledge this kind of mayhem is a problem. This step is difficult because firefighting heroics and the rush of adrenaline from last-minute deadlines becomes “how things are done around here”.

As an outside observer, I usually see little need for subjecting employees to this kind of work condition and believe it lowers engagement. Until teams align that overburdening staff is a problem, it will continue unabated.

The final step is to identify the root causes of the mayhem and eliminate them.

What sort of unnecessary mayhem do you experience in the workplace?

(NOTE: The attached video is only related to this post because of the title and I thought it was a cool rockabilly song!)

While cleaning up various packaging after my son’s first birthday, I noticed an interesting pamphlet from toy manufacturer Fisher-Price. They have a “Play Lab” where they observe kids and families using their products to determine how to make them better!

Watching how your customers interact with your products and services will help your organization be more successful. You will be able to better understand their needs to create new things to satisfy them. You will spend time improving what matters because you are able to improve based on what problems you see them experiencing.

Here are a few quotes from the flyer:

…start in our Play Lab, where thousands of children test our toys in a fun, nurturing environment. And our product designers get right down on the floor with them.

Have more than the customer-facing staff observe your customers. Help others see how their work supports your customers. Have leaders gain first-hand knowledge of how your products and services are being experienced.

…Fisher-Price does thousands of in-home tests – so we can really grasp how kids interact with our toys, how toys fit into their lives and how they play.

While simulated environments can tell you a lot, there is even deeper learning when observing in a natural setting.

…we created Mom Panels, informal groups where moms can see our toy development and let us know what works for them and their children, and what doesn’t.

Engaged and loyal customers will tell you what is broken about your system if you just ask. They will also tell you what is valuable to them.

Does your organization have a “Play Lab”? If not, create the opportunity for many different people to be able to watch your customers use your products and services.

“Employees will not be able to give customers the attention they deserve if they fear making a mistake, if they get blamed for problems that are outside of their control, if chaos prevents them from doing their work efficiently, if decisions depend on a manger’s whim instead of data and logic, or if managers focus more on figures than on customers. They need to believe they are an important part of a team that operates to serve customers.” – Brian Joiner: Fourth Generation Management, Chapter 6: Customer Focused Strategies, page 100

Technology can sometimes seem like the right way to address issues but most people do not know about the extra problems it can create. You may get a short-term win with technology but end up suffering in the long-term.

If your hospital or organization in on a Lean journey, technology can sometimes go against your philosophy and management system.

Here are some things to consider if you are looking at technology:

Never automate a bad process. Eliminate waste and understand what the process really needs before you find a way to make it faster. Quicker waste is still waste.

IT systems should fit the process, not the other way around. In The Birth Of Lean, there was an early Toyota document with the following: “It is not a conveyor that operates men…it is men that operate a conveyor…” So often people change processes to meet the rigidity of the technology. Ensure the technology does not force standardization that has waste, lowers quality, or makes no sense.

Be able to make changes after it is implemented. So often organizations are stuck with wasteful systems because nobody has knowledge to make iterative improvements or the cost to bring someone in is so high that nobody fixes it until it is totally broke.

Trial first instead of piloting. Pilots usually happen after you buy the system. I have rarely seen organizations stop implementation if a pilot does not work out like they expected. Organizations usually just change their messaging and training to fit what the technology can do instead of ensuring it does what they wanted it to do. Trialing is part of PDCA thinking and will help ensure the IT system meets the needs of the process without being financially committed to rolling it out.

Know the problem you are addressing. With today’s technology, there are all sorts of bells and whistles that seem great. Although impressive, the added features may be more than needed (overprocessing waste) and can sometimes distract from why you were looking for technology. These ‘extras’ can also add complexity to your processes.

I think technology can be embraced in Lean organizations but it is important to ensure it is thoroughly tested, reliable, and improvable before you commit to implementing.

I had a great experience recently when I was able to sit in on a meeting that was being led by a client. They were debriefing an event and dealing with some uncovered problems afterwards. I was thinking of some potential counter-measures or approaches to understand the problems deeper but the team came up with everything I was thinking on their own!

As leaders and consultants, it is so important to give people the space and time to figure things out on their own. Be there to help if struggling, but allow them the ability to experiment and try things. Coach to the method of thinking but not the solutions.

For me, Lean is about developing thinking and getting results. Unless there is an emergency requiring quick action, no result is worth sacrificing the time spent developing thinking. Investing in people will help organizations thrive in the long term. A company or hospital with more Lean thinkers will be more competitive than another that is just implementing the tools.

Does your hospital have a system to ensure nurses have working equipment or they know how to get them fixed?

I recently visited a hospital where the answer would be “NO”.

Last week, a family member needed a day surgery procedure done at a local hospital. There were signs in the prep/recovery room touting their move to electronic medical records and no longer needing paper charts. The problem for the nurse was, the Computer On Wheels (C.O.W.) did not work. The nurse was unable to access or update the electronic chart!

A second nurse came in during the morning before the procedure to try to troubleshoot the malfunctioning C.O.W. It was decided to grab a C.O.W. from another room and use it instead. I am not sure if other nurses had to search for the missing C.O.W. now that it has been moved into our room where it sat there for four hours. A third nurse eventually pulled it away to put back where it belonged.

The first nurse came back in and tried to access the original C.O.W. in our room and commented “This still doesn’t work yet?”

I looked at the C.O.W. and there was no signage about how to troubleshoot or who to call. I do not know if a nurse tried calling their helpdesk out of my view but it looked like nobody knew what to do with the broken computer. It seemed like nobody knew who was to take charge in fixing it. One can almost infer they expected it to magically fix itself!

Three nurses spent time reacting to faulty equipment that could have been better used providing care to patients. Instead of spending their creativity solving patient issues, they use it creating workarounds.

Lean thinking can help hospitals put systems into place to ensure equipment always works. Procedures can be created for what to do when something is broken and how to handle. Make things visual so staff doesn’t have to rely on memory or look up procedures because instructions are attached to the item being used.

Helping remove waste and frustration from those giving care with make a better experience for those receiving care.

I have been reading the excellent book ON THE MEND about ThedaCare’s Lean journey. The authors talk about the importance of having a burning platform to drive change since the clearest way to get someone to jump into the water is to burn the platform.

I started to think about what happens when an organization takes this concept too far and begins to torch the entire field and surrounding buildings. Everybody thinks their platform is the one that should be lit and nobody is controlling the distribution of matches, lighters, or moltov cocktails. Here are some of the results:

SMOKE FILLS AREA: Direction becomes unclear. People can not see where they are headed.

PEOPLE BECOME TRAPPED: If all the surroundings are on fire, people can not reach the water to feel a sense of accomplishment. People will become tired trying to fight all the flames and will either melt-down or burn-out.

THINGS DIE: Even if firefighters quickly dash in to extinguish the blaze, not everything can be saved since the fire covers a lot of ground. People, equipment, and resources such as water become scarce as many people fight the fire across such a wide area. A lot of effort is made but only ash remains.

Organizations need to work at aligning over lighting only a few platforms to get effective change for their performance. Identify your organization’s pyromaniacs to help them not set everything else on fire!

WHY is one of the most important questions for your Lean journey. Here are the reasons:

IMPROVE ROOT CAUSES – Instead of fixing symptoms, determine what is causing the problem by asking WHY five times (Wikipedia example)

GOOD CHANGE MANAGEMENT – Ensure your staff knows WHY an improvement is made or the reasons for standardization. This is only helpful if the answer to WHY isn’t “because I told you so”.

SUSTAIN GAINS – Just because a brilliant process has been designed for standardization does not mean all staff will follow it. Leaders need to ask WHY an individual does not perform to standard. It could be because of lack of training, a misunderstanding of WHY change was made, a physical or space limitation preventing the ability to follow it, a flat out refusal to adhere to it, or many other reasons. You can not sustain unless you find out WHY people are not following it.

BETTER TEACHING – In my experience, teaching the reasons WHY behind the Lean tools helps people think critically. Just explaining how the tools are used can lead to a misuse of them.

IMPACT PERFORMANCE – Your organization probably has a lot of demand for projects. Find out WHY the projects are needed and use that information to select those that impact your performance. Projects can keep a lot of people flurrying in activity but are not always conceptualized to achieve improvement for the organization’s performance, creating value for customers, or achieving strategic aims.